Do Patients Make Poor Health-Care Consumers or is a lack of documentation just hampering good decision making?

Shirley Wang in the Wall Street Journal reports on a TEDMed talk by Jon Cohen, Vascular Surgeon and CMO Quest Diagnostics.

I look forward to seeing the TEDMed video until then key takeaways for me:

“The average American spends twice as much time before buying a TV as they do looking for a doctor… …Consumer-driven healthcare doesn’t work because people don’t want health care… …It’s also difficult to judge quality when it comes to health care… …so what could help patients become savvier consumers? Getting people to want the same high quality of care for themselves as they wish for their children, intense desire trumps all barriers”

My thoughts:

We don’t always need/want a professional/community to tell us what we need

Okay first I have to make an open admission: I am that guy who asks the doughnut seller. When I’m in a foreign city with a problem (like perhaps choosing a place to eat, decide on a show, etc) I surprise colleagues by not turning to the 3 or 4 smartphones that are connected and on my person (yes I’m really that sad) but I ask someone who I judge is similar to me but local and really in the heart of the community.

It nearly always works a treat and if it doesn’t I learn something much more valuable about the quality of my judgement. It’s done me very well so far and I don’t have a son who’s a vascular surgeon and CMO at a global laboratory firm that generates multiple billions of dollars annually.

Family isn’t always best when it comes to healthcare

I think it’s safe to say there are good reasons why people don’t consult their family even if they are great Doctors. Privacy, additional pressure, he’s got enough on his plate without worrying about me, I don’t want him to know I’m absolutely ready to burst out crying, I know it probably won’t happen but maybe the friends he refers me to might breach confidentiality and discuss things with him, I knew this Doctor when he had to resit his cardiology exams, etc, etc.

We don’t always feel a synergy with other patients who use rating websites

Healthcare experiences are a very personal thing so if you’re not the type to post judgements of these online why would you value a website that presents the personal opinions of people who aren’t like you?

Although I have a list of Doctors that I know are great I’m like most people in that I’ve never posted an opinion on a rating website about a Doctor I’ve been treated by so I’m inclined to presume that those that do this either aren’t at all like me and may have an obscure agenda, a gripe about a particular Doctor, are people who champion everthing they encounter, have some other problem they are projecting onto their Doctor experience, etc, etc.

Life Experiences and Beliefs

Although contrary to common sense it’s surprisingly common for consumers to think emotionally when it comes to important decisions, this isn’t something that’s going to change quickly.

All too often onlookers dismiss the importance of beliefs or experiences that often lie at the centre of our motivations as individuals eg. perhaps the Donut seller was wearing a set of Rosary beads or selling his donuts at a charity stall for Cancer Research, perhaps Jon’s father had a personal experience where a Doctor he’d never met before had gone beyond the call of duty in the middle of the night and waived his charge – if ‘they’ can give me a break I can cut them one, perhaps Jon’s father is the type of guy that likes Doctors that keep him waiting because he knows they’re the type of Doctors who are prepared to give a patient who needs it an extra free 30 mins even if this means his whole afternoon schedule is put out, etc, etc.

I might be very wrong but I think it’s unlikely that the power of such personal experiences will be shaken up by online ratings made by strangers.

Risks

There is no doubt that the healthcare market in the USA is a sickcare market. As such it’s important to realise that our personal experiences of it typically take place at a time when our bodies and/or minds are failing. This clashes with media that works best by showing healthy images and positive outcomes that are typified by this cool Henry Ford Hospital video showcasing how an Urologist is conducting his rounds via Facetime calls on an iPad. Do you really think this would be possible if the outcome of the operation wasn’t positive?

Imagine if this patient was unfortunate to have been told some bad news? Take it from me it wouldn’t be long before that iPad went flying across the room followed by the words “You get down here and talk to me!”.

Those trying to emulate a rating website that reviews brand new consumer electronics or movies in the world of sickcare are in my opinion failing to recognise that in reality not all interventions can be positive because we are typically managing disease and trying to patch up situations that have actually already gone wrong.

Desire? I can’t have desire until I have information

Jon’s call for us to try and create “intense desire” in patients by making them “want the same high quality of care for themselves as they wish for their children” in the hope that it will trump “all barriers” has me thinking the opposite.

Do this and you’ll just create more frustration for patients as they build intense desire around the trivial things they already judge Doctors by (eg. whether their office calls back quickly, holds evening hours, has parking, etc) or the small unfortunate comments and confusions that they can recall from a process that isn’t recorded.

As I posted at length before the starter gun for innovation in healthcare is better documentation

Takeaway

I don’t think we should be blaming the key stakeholders (patients) for the way they make choices but focusing on the failure of healthcare providers to bring transparency to the services they offer.

In my opinion making the invisible visible starts when we give patients the time they need to share their important history and provide them with a comprehensive written record as part of every consultation. You could wait around 20 years for complete reform of the US healthcare system or vote with your feet for Doctors who prepared to introduce tested and proven processes that enable their work to be recorded and measured.

2 Responses to Do Patients Make Poor Health-Care Consumers or is a lack of documentation just hampering good decision making?

  1. [...] mHealth Insight blog has another point of view: “I don’t think we should be blaming the key stakeholders (patients) for the way they [...]

  2. [...] In April I posted about my thoughts on the Wall Street Journal’s report on Quest Diagnostic’s Chief Medical Officer Dr Jon Cohen’s TedMed 2012 talk about “why patients don’t behave like wise consumers when it comes to choosing Doctors”. [...]

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